Montek may rethink healthcare proposal

A public uproar against the Planning Commission's intention to "corporatize healthcare" seems to have forced the Plan panel to reconsider its intentions.

Deputy chairman of the Commission Montek Singh Ahluwalia met Dr K Srinath Reddy and Dr Gita Sen – members of the high–level expert group (HLEG) on universal health coverage (UHC) – on Thursday evening, and indicated that the "panel's draft proposal will be revised next week after it received comments from both the health ministry and the HLEG."

The Commission's dramatic draft policy had earlier asked for a reversal of the long–standing public health policy, ending governments' dominant role in providing health services and transiting to greater privatization of the health sector – along the lines of 'the managed care' system that is followed in the US and Mexico.

Dr Reddy after meeting Ahluwalia told TOI "The proposal is still a draft and has not been finalized. The Commission has sought the comments of both the HLEG and the health ministry and intends to revise the draft next week. We will send our concerns and point out the recommendations we made in our report earlier, some of which may not have been correctly interpreted."

On Tuesday, the Union health ministry sent its comments to the Commission openly accusing the Plan panel of overlooking "suggestions/directions as emerged from the working group reports and introducing ideas and approaches which have never been subjected to any level of consultation or discussion."

The ministry has expressed worry on the panel's draft chapter that indicates a total public investment on health in the 12th Plan to be only 1.5% of GDP as against earlier plans to raise total health expenditure to 2.5% of GDP by the end of 2017.

The health ministry says it has strong reservations against the panel's proposal for a National Health Mission (NHM) saying, "the way it has been articulated is fraught with the danger of neglect of rural areas which requires more attention."

The ministry says that it was decided in a recent meeting that there will be a NHM with two sub–missions – National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM). While the implementation structure will be common for both, the resource allocation and strategy both for rural and urban areas will be in keeping with their respective needs.

The letter says, "The health set–ups in rural areas conform to a uniform pattern, while in urban areas it varies widely not only from state to state but also for different category of local bodies within a state such as mega cities, metropolitan cities or municipal towns. Hence, there cannot be a uniform approach for both rural and urban areas. It must also be taken into account that the Cabinet has already approved the continuation of NRHM during the 12th Plan. A separate proposal for NUHM is under formulation."

The ministry also points to how the Plan panel document has used the recommendations on UHC by the HLEG "rather selectively" with focus on a managed care approach with an enhanced role for the private sector.

"The suggested pilot models heavily promote corporatization of health. The ministry has been advocating developing a strong public health system to be supplemented by private sector participation. This has also been highlighted by HLEG which advocates strengthening of primary care as well as district hospitals," the letter added.

The ministry says that the suggested re–structuring of the central sector schemes needs a fresh look.

It has been suggested that all the central sector programmes would be consolidated to six schemes that include AYUSH (ayurveda, unani, siddha and homeopathy) and health research and 24 centrally sponsored schemes under the NHM.

The ministry's letter says this would create "substantial confusion and will be unwieldy." Hence, it has been suggested that the programmes under the department of health can be brought under six different schemes, including the NHM. The NHM will have four different components of NRHM, NUHM, communicable diseases and non–communicable diseases.

"The programmes of department of AYUSH, AIDS control and health research should be completely separate," the health ministry says.

The Plan panel's prescription of a privatized healthcare will diminish the role of government in delivering primary healthcare to essentials like antenatal care leaving the more lucrative medical treatments to the 'managed–care' system where private players will compete with the cash–strapped government run–hospitals to run the 'networks'.

Sources say at stake in this controversial move is the huge allocation for the health sector that is set to rise substantially as the government raises its investment in the 12th Plan to Rs 10,85,369 crore. Now, almost all health funds provided to states are part of the flexible arrangement to help them set public health priorities.

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